title: Low-dose intradermal versus intramuscular trivalent inactivated seasonal influenza vaccine in lung transplant recipients.
abstract: BACKGROUND
  In this study we compared the immunogenicity of influenza vaccine administered intradermally to the standard intramuscular vaccination in lung transplant recipients.
  
  
  METHODS
  Patients were randomized to receive the trivalent inactivated seasonal 2008-9 influenza vaccine containing either 6 μg (intradermal) or 15 μg (intramuscular) of hemagglutinin per viral strain. Immunogenicity was assessed by measurement of geometric mean titer of antibodies using the hemagglutination-inhibition (HI) assay. Vaccine response was defined as a 4-fold or higher increase of antibody titers to at least one vaccine antigen.
  
  
  RESULTS
  Eighty-five patients received either the intradermal (n = 41) or intramuscular (n = 44) vaccine. Vaccine response was seen in 6 of 41 patients (14.6%) in the intradermal vs 8 of 43 (18.6%) in the intramuscular group (p = 0.77). Seroprotection (HI ≥ 1:32) was 39% for H1N1, 83% for H3N2 and 29% for B strain in the intradermal group vs 28% for H1N1, 98% for H3N2 and 58% for B strain in the intramuscular group (p = 0.36 for H1N1, p = 0.02 for H3N2, p < 0.01 for B). Mild adverse events were seen in 44% of patients in the intradermal group and 34% in the intramuscular group (p = 0.38).
  
  
  CONCLUSIONS
  Immunogenicity of the 2008-9 influenza vaccine given intradermally or intramuscularly was overall poor in lung transplant recipients. Novel strategies for influenza vaccination in this population are needed.
authors.affiliation: Infectious Diseases Service, University Hospital Center (CHUV) and University of Lausanne, Lausanne, Switzerland. oriol.manuel@chuv.ch
authors.forename: Oriol
authors.initials: O
authors.lastname: Manuel
authors.forename: Atul
authors.initials: A
authors.lastname: Humar
authors.forename: Carine
authors.initials: C
authors.lastname: Berutto
authors.forename: Leticia
authors.initials: L
authors.lastname: Ely
authors.forename: Stefano
authors.initials: S
authors.lastname: Giulieri
authors.forename: Dale
authors.initials: D
authors.lastname: Lien
authors.forename: Pascal R
authors.initials: PR
authors.lastname: Meylan
authors.forename: Justin
authors.initials: J
authors.lastname: Weinkauf
authors.forename: Manuel
authors.initials: M
authors.lastname: Pascual
authors.forename: Roland
authors.initials: R
authors.lastname: Nador
authors.forename: John-David
authors.initials: JD
authors.lastname: Aubert
authors.forename: Deepali
authors.initials: D
authors.lastname: Kumar
mesh_terms: D000328:Adult; D000368:Aged; D000914:Antibodies, Viral / Q000097:blood; D005260:Female; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000276:immunology*; D053122:Influenza A Virus, H3N2 Subtype / Q000276:immunology*; D009981:Influenza B virus / Q000276:immunology*; D007252:Influenza Vaccines / Q000008:administration & dosage / Q000276:immunology; D007251:Influenza, Human / Q000276:immunology / Q000517:prevention & control; D007271:Injections, Intradermal; D007273:Injections, Intramuscular; D016040:Lung Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D015164:Vaccines, Inactivated / Q000008:administration & dosage / Q000276:immunology
chemical_list: D000914:Antibodies, Viral; D007252:Influenza Vaccines; D015164:Vaccines, Inactivated